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1 From the Department of Radiology, University of British Columbia and Vancouver Hospital and Health Sciences Centre, Vancouver, BC, Canada
2 From the Department of Radiology, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
3 From the Department of Pathology, University of British Columbia and Vancouver Hospital and Health Sciences Centre, Vancouver, BC, Canada
Purpose: To assess the diagnostic accuracy of the chest radiograph in the evaluation of acute pulmonary complications in immunocompromised patients.
Methods: The study included the chest radiographs in 149 consecutive acute pulmonary complications seen in immunocompromised patients in whom a definitive diagnosis was made. Twenty-four complications were in patients with AIDS and 125 were in non-AIDS patients. The radiographs were separately reviewed in random order by two independent observers. The observers assessed pattern and distribution of radiographic findings and recorded their first-choice diagnosis.
Results: The most common complication in patients with AIDS was Pneumocystis carinii pneumonia (n=21). In the non-AIDS patients, the most common complications included invasive aspergillosis (n=25), drug reaction (n=21), and Pneumocystis pneumonia (n=20). A correct first-choice diagnosis was made in 90% of patients with AIDS and 34% of non-AIDS patients. In AIDS patients with Pneumocystis pneumonia, the correct first-choice diagnosis was made in 41 of 42 (98%) readings by the two observers. In non-AIDS patients with invasive pulmonary aspergillosis, drug reaction, and Pneumocystis pneumonia, the correct first-choice diagnosis was made in 38%, 26%, and 43% of readings, respectively.
Conclusion: The chest radiograph is helpful in the differential diagnosis of acute lung disease in the immunocompromised host, particularly in patients with AIDS.
Submitted on February 14, 1995
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